ABSTRACT: Cardiovascular disease (CVD) is now the leading cause of mortality in Haitian adults. Our preliminary data suggest that hypertension is the single most important CVD risk factor in Haiti and may be driven by poverty-related social and environmental determinants. However, the prevalence, incidence, major risk factors, and social and environmental determinants are unknown. Longitudinal cohort studies are urgently needed to address these knowledge gaps in order to develop interventions to prevent CVD and improve health outcomes of Haitians in both Haiti and in the United States. We propose to fill this gap by establishing the first longitudinal cohort to study the natural history of CVD in Haiti. The cohort will include 3,000 adults >18 years in Port-au-Prince using multistage random sampling, and follow them for 2 to 3.5 years depending on the timing of study enrollment. We anticipate that hypertension prevalence will be ?10% in 18-30 year olds, that hypertension incidence will be >10 events/1000 person years, and that both prevalent and incident hypertension will be associated with poverty-related social and environmental determinants. We will also examine the association of determinants and risk factors with CVD. We will biobank whole blood, serum, plasma, saliva, stool, and urine samples for future studies. Our Specific Aims are to: 1. Establish a population-based cohort of 3,000 adults in Port-au-Prince and assess the prevalence of CVD risk factors and diseases and their association with social and environmental determinants. a. Cardiovascular risk factors include hypertension, diabetes, obesity, dyslipidemia, kidney disease, poor diet, cigarette smoking, physical inactivity, and inflammation. b. Cardiovascular diseases include myocardial infarction, heart failure, stroke, and CVD mortality. c. Determinants include stress, social isolation, depression, food insecurity, and lead exposure. 2. Determine the incidence of CVD risk factors and diseases and their association with social and environmental determinants. This study will provide important insights into the epidemiology of CVD in Haiti. The study also builds a platform for future research by establishing a population-based cohort, collecting data on other important chronic diseases in Haiti (e.g. diabetes, renal disease), creating a biobank, and using measures and outcomes that are directly comparable to existing US CVD cohorts. Our ultimate goal is to translate new research findings from this study into pragmatic prevention and treatment interventions to fight the CVD epidemic in Haiti and in Haitian immigrants in the US.